Broadening the focus of epidemiology and public health training.

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The mission of the Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET) is to strengthen international public health capacity through initiating and supporting field-based training programs that enhance applied epidemiology and public health interventions.1 The vast majority of the programs investigated by TEPHINET professionals are directed at communicable diseases. This emphasis, although understandable, ignores the reality of the burden of disease in many countries where TEPHINET is in place: namely, that 59% of the deaths in the world and 46% of the global burden of diseases are due to noncommunicable diseases (NCDs) and mental health.2,3 Even in developing countries, NCDs and mental health are the major causes of disability. And in all countries, by 2020, it is expected that the proportion of death and disability due to NCDs will increase. Just over 30% of all deaths in developing countries occur between the ages of 15 and 60 years, compared with 15% in richer regions. These are due mostly to NCDs and injury (except in sub-Saharan Africa, where HIV/AIDS is taking its toll). A recent global survey that obtained data from 167 of 191 World Health Organization member states confirmed that national capacity is weak in preparing for the growing epidemics of NCDs.4 Less than half of the countries reported having policies for NCDs, and a similar proportion reported having no surveillance systems for the major NCDs. In annual health information systems, just over one-quarter included information on trends in key risk factors. TEPHINET might build on existing training opportunities by encouraging systematic surveillance studies on NCD risk factors in defined populations. The World Health Organization has developed STEPwise (a simplified framework for surveillance using a stepwise approach)5 to help developing countries obtain better data for decisionmaking and to link these data to health promotion and disease prevention efforts. It also provides practical training and field experience for postgraduate students, thereby enhancing capacity in a broader area of public health than is traditionally offered in developing countries. An example of this framework in practice is provided by the Butajira Rural Health Programme, a collaborative research undertaking between the University of Addis Ababa in Ethiopia and the University of Umea in Sweden.6 This demographic surveillance site provides both the infrastructure for community-based studies as well as a continuous, sustained framework for research and training for public health students who, in turn, have made significant scientific contributions. As this program shows, the opportunity to seek synergies to work with TEPHINET is too good to be missed!